A patient who is being seen in the community mental health center ...

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A patient who is being seen in the community mental health center for PTSD is being considered for EMDR (Eye Movement Desensitization and Reprocessing) therapy.
 
  The nurse is being asked to conduct an assessment to validate the patient's appropriateness for this treatment. Which of the following pieces of data, collected by the nurse, are most important to document when determining appropriateness for treatment with EMDR? Select all that apply.
 
  A. The patient has a history of a seizure disorder.
  B. The patient has a history of ECT.
  C. The patient reports suicidal ideation with a plan.
  D. The patient has been using alcohol in increasing quantities over the last 3 months.

Question 2

A nurse who works on an inpatient psychiatric unit is working on developing a treatment plan for a patient admitted with PTSD. The patient, a military veteran, reports that sometimes he thinks he sees bombs exploding and the enemy rushing toward him.
 
  He has had aggressive outbursts and was hospitalized after assaulting a coworker during one of these episodes. Which of these interventions by the nurse are evidence-based responses? Select all that apply.
 
  A. Collaborate with the patient about how he would like staff to respond when he has episodes of re-experiencing traumatic events.
  B. Tell the patient it is not appropriate to hit other patients or staff and if that occurs he will have to be discharged from the hospital.
  C. Contact the doctor and recommend that the patient be ordered an antipsychotic medication.
  D. Refer the patient to a support group with other military veterans.

[sylvia]

Answer to Question 1

ANS: A, C, D
Items A, C, and D are all factors that would contraindicate the use of EMDR. A history of ECT is not directly relevant in determining appropriateness for EMDR.

Answer to Question 2

ANS: A, D
Collaborating with the patient demonstrates an environment of mutual respect and is helpful in establishing a trusting relationship. Both of these are identified as essential in effective treatment of PTSD. Evidence also supports that a group with other people who have experienced similar traumas is helpful in reducing the sense of isolation that some people with PTSD experience. Items B and C are incorrect since they both reflect an inaccurate understanding of the dynamics of PTSD.

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